Nutrition Flashcards
what are the 6 basic classes of nutrients?
protein fat carbohydrates minerals vitamins water
how much water should an animal have per day?
20-70 ml/kg/day
what is the normal urine output?
2ml/kg/hr
why are vitamins important?
for energy metabolism and biochemical reactions
which vitamins are water-soluble?
B and C
what are the fat-soluble vitamins?
A, D, E and K
what are the macrominerals?
sodium chloride calcium phosphorous magnesium potassium sulphur
what are the most important microminerals?
iron copper zinc manganese iodine selenium
why are cats obligate carnivores?
they cannot synthesise taurine within the body
what are the main functions of protein?
energy source
regulation of metabolism
cell and muscle fibre structure
tissue growth and repair
what are the essential amino acids?
phenylalanine valine tryptophan threonine isoleucine methionine arginine leucine lysine taurine (cats only)
what can taurine deficiency in cats cause?
blindness, heart problems
what can excess dietary protein cause?
liver and kidney problems
what can protein deficiency cause?
poor growth, muscle and weight loss dull hair/coat reduced immunity oedema (hypoalbuminaemia) death
what are the functions of fats?
energy source
aid absorption of fat-soluble vitamins
enhance palatability
source of essential fatty acids
neural development
what can a deficiency in essential fatty acids cause?
impaired reproduction impaired wound healing dry coat flaky skin eczema - hot spots
what are the 3 main groups of carbohydrates?
monosaccharides (glucose, fructose)
disaccharides (maltose, lactose, sucrose)
polysaccharides (starch, glycogen, fibre)
what is the function of carbohydrates?
energy - may be converted to fat
metabolic requirements for glucose
what is fibre made of?
indigestible polysaccharides - cellulose, lignin, pectin
what is the function of fibre?
adds bulk to the faeces
prevent constipation and diarrhoea
role in correction of obesity
role in regulating blood glucose levels in diabetes
what is the ideal body condition score for dogs?
4-5
what is the ideal body condition score for cats?
5
what is the basal energy requirement?
energy expended during sleep, 12-18hrs after feed, in a thermoneutral environment
what is the resting energy requirement?
BER plus energy expended for recovery from physical activity and feeding
Hospitalised patients
what is the maintenance energy requirement?
energy required by a moderately active animal
doesn’t include energy for growth, lactation or work
how do you calculate the RER for animals <2 or >45kg?
70 x (bw kg)^0.75
how do you calculate RER for animals 2kg-45kg?
30 x (bw kg) + 70
how is MER calculated?
RER x appropriate lifestage factor
what can cause obesity?
modern lifestyle
neutering
overfeeding
poor owner understanding
what are the possible consequences of obesity in dogs and cats?
hepatic lipidosis
joint disease
exercise intolerance
diabetes mellitus
cardiorespiratory disease
surgical implications
FLUTD
how do you calculate MER for an overweight animal?
based on ideal weight, not current weight
what is a realistic weight loss target?
- 8-1% for dogs
0. 5-1% for cats
what should obesity diets be?
nutritionally balanced
high protein
formulated for joint health
adequate levels of L-carnitine
what is L-carnitine?
non-essential amino acid
transports long-chain fatty acids into the mitochondria for use in beta-oxidation
(encourages use of fat as an energy source)
what is the function of L-carnitine in an obesity diet?
helps encourage use of fat for energy and reduce fat storage
reduces risk of hepatic lipidosis in cats
what should be considered in diets for GI disease?
highly digestible proteins and starch
MOS and FOS (prebiotics)
EPA/DHA (omega 3 EFAs)
psyllium
high fat vs. low fat
lypex supplement in patients with EPI/malabsorption syndromes
what is MOS and FOS?
mannan oligosaccharides from yeast cell walls
fructooligosaccharides from chicory/grains/barley/wheat
when might hypoallergenic diets be prescribed?
management of dogs with food allergy/hypersensitivity/intolerance
also useful for IBD and EPI
what are hydrolysed proteins?
proteins in food which have been broken down to the point where they no longer provoke an immune response
what components do hypoallergenic diets usually contain?
hydrolysed proteins/novel protein
skin barrier protection (B vitamins + amino acids + zinc + linoleic acid)
omega 3 fatty acids (EPA/DHA)
digestive security (beet pulp, FOS/MOS, zeolite)
what is the purpose of omega 3 fatty acids in hypoallergenic food?
help support skin and GI mucosal integrity
what is the purpose of zeolite in hypoallergenic food?
help support a healthy intestinal environment
what % of total energy should come from protein in convalescent diets?
30-50%
what forms do convalescent diets come in?
liquid, powdered and solid wet
why are critically ill patients at high risk of malnutrition?
catabolic depletion and rapid breakdown of energy and protein stores
how can you encourage a hospitalised patient to eat voluntarily?
calm environment
provide fresh food
warming the food - make sure it is palatable
make sure no physical barriers e.g. buster collars, saucers for cats
only try one food at a time
when should an enteral feeding tube be considered?
when an animal cannot get adequate caloric intake through voluntary eating
how can we alter food to help with dental health?
provide dry food, large kibbles oral hygiene chews phosphate salts bind salivary calcium use of anti-gingipain IgY addition of omega 3s and xylitol (not dogs?)
how can we encourage patients to eat spontaneously?
try different textured and strong smelling foods, warmed foods
consider giving antiemetic medication/appetite stimulants/analgesia/pro-kinetics if required
TLC - grooming, cuddles, playing
offer food away from kennel
try their favourite treats
what should we avoid doing when encouraging patients to eat spontaneously?
food buffets in kennels
introducing prescription diets (may create aversion)
don’t keep offering food if condition seems to be worsening - consider assisted feeding
when is a feeding tube placed?
if a patient has been anorexic for 48 hours or more
if the vet anticipates the patient to be anorexic after a surgical procedure
if there is trauma to the mouth/head/neck
to administer oral rehydration or medication (maintaining normal ‘ins’ and ‘outs’)
what types of feeding tube are there?
naso-oesophageal
oesophageal
percutaneous endoscopic gastrotomy (PEG) tube
what equipment is required to place a naso-oesophageal tube?
surgical stapler correct feeding and correct french gauge syringes (correct size for feeding tube) proxymetacaine (LA) sterile lubricant gloves sterile water tape
briefly describe how to place a naso-oesophageal tube.
- measure correct size tube (tip of snout to 7th rib in cats/ 8th rib in dogs)
- apply proxymetacaine to one of the nares and around the nostrils
- apply sterile lubricant to end of tube and put patient in sitting position with control of the head
- direct tube in a medio-ventral-caudal direction - first part quickly, keep inserting until reach mark on tube
- check tube has negative pressure
- apply 10mls water for injection and monitor patient for respiratory distress
- apply tape to tube by the nares, staple/superglue in place to patients face (repeat again between eyes and between ears)
- place a buster collar
how do you check placement of a N/O tube?
check for negative pressure using a syringe
administer 10mls of water and monitor for respiratory distress
how do you administer a N/O tube feed?
- calculate required amount
- wear non-sterile gloves and draw up required amount into appropriate syringe
- pre-warm food within syringes in a warm water bath
- check for negative pressure
- administer 10mls water as pre-flush
- administer feed slowly over 10-15 mins, watch for signs of nausea/regurgitation (slow down/stop if seen)
- administer 10mls flush afterwards
what are the nursing considerations for the N/O tube patient?
keep face and muzzle clean
tempt with food before every feed
take buster collar off for walks if putting it back on is well-tolerated
avoid food buffets in kennels
avoid offering prescription diets
how long can a N/O tube be used for?
up to 7 days
how do you remove a N/O tube?
remove by removing staples from patient or peeling away tape
using non-sterile gloves, pull gently out of the patients nose
what are the contraindications for N/O tube placement?
patient who are comatose or have limited gag reflex/risk of aspiration
cat flu/congestion
rhinitis/epistaxis/head trauma
oesophageal disease
marked regurgitation
persistent vomiting
impaired gastric outflow
if nutritional support needed for >7 days
what are the possible complications with N/O tube feeding?
patients removing their own tube
not getting negative pressure before a feed - tube displacement?
infection
reluctance to eat due to irritation from tube
aspiration
large dogs requiring very large feeds, small lumen
blockage
what equipment is required for placing an oesophageal feeding tube?
feeding tube + correct french gauge
sterile and non-sterile gloves
curved artery forceps
surgical prep equipment (clippers/scrub/drape)
scalpel blade
bandage material
how to you maintain an oesophageal feeding tube?
check stoma site 2x daily and assess for swelling/discharge/pain/redness
clean with 1:10 iodine
check for negative pressure and flush sterile water down the tube
redress
what other nursing considerations should be given when nursing a patient with an oesophageal tube?
tempt with food before every feed
no neck collars/slip leads
administer medication through the tube to try and foster a positive relationship with food
avoid food buffets in kennels
avoid offering prescription diets
how do you administer an oesophageal tube feed?
wear non-sterile gloves
pre-warm food syringes in warm water bath
check for negative pressure and administer 10ml flush
administer food slowly over 10-15 mins
flush again with 10ml and watch for signs of regurgitation/reflex/nausea
administer any medication
administer flush
how long can an oesophageal tube be in place?
weeks to months
how you you remove an oesophageal tube?
wear non-sterile gloves
cut suture holding the tube to the skin, gently pull away from patient
apply a primary dressing to cover the stoma site
can be managed by owner at home
what are the contraindications for placing an oesophageal feeding tube?
persistent vomiting
reduced/impaired gastric outflow
comatose, recumbent or dysphoric patients - aspiration risk
oesophageal disease
what are the possible complications of an oesophageal tube?
infection
loss of negative pressure - displacement
suture failure
blockage (rarer)
what is a percutaneous endoscopic gastrotomy tube?
a tube which runs through the skin of the abdomen and the stomach wall and into the stomach cavity
what equipment is required for placing a PEG tube?
correct size PEG tube kit (guide wire, needle/catheter, PEG tube)
endoscope
endoscope forceps
suture material
surgical prep equipment (scrub, drapes)
how do you provide a feed through a peg tube?
wait 24 hours after placement
wear non-sterile gloves and pre-heat feed in a warm water bath
aspirate contents of stomach until you get negative pressure. measure volume and replace back through PEG tube
adjust feed as necessary and administer slowly over 20-25 mins
administer any medication
flush 10ml water through tube
what are the nursing considerations for a PEG tube?
try to administer oral medications through PEG tube where possible
check stoma site twice daily as for O-tube care
stockinette instead of wrap dressing
tempt with food before every meal
how long can a PEG tube be in place?
cannot remove for at least 7 days
can be in place for months
how is a PEG tube removed?
can cut tube and will naturally pass through or firmly pull mushroom out of the stoma site?
what are the advantages of a N/O tube?
no GA required
quick to place
easy removal, no healing required
well-tolerated
what are the disadvantages of a N/O tube?
short term
risk of aspiration
irritating - can inhibit spontaneous eating
can block due to narrow lumen
feeds are time-consuming
what are the advantages of an oesophageal tube?
can administer larger volumes more easily
can administer medications more easily
can be managed at home with owner
what are the disadvantages of an oesophageal tube?
GA required
stoma site can become infected
can dislodge if patient vomits or regurgitates, aspiration risk
can get blocked
time-consuming feeds
what are the advantages of a PEG tube?
large lumen to administer medication
can be in situ for months, managed by owner
what are the disadvantages of a PEG tube?
GA required
has to be in situ for 7 days before removal - not good for short-term support
cannot use for first 24 hours
infection risk
how much food can be given 24 hours after a PEG tube is placed?
1/3rd RER
how much food can be given 48 hours after a PEG tube is placed?
2/3rd RER
how much food can be given 72 hours after a PEG tube is placed?
all of RER
what is the exocrine function of the pancreas?
synthesise and excrete digestive enzymes
which dogs are pre-disposed to pancreatitis?
terriers, miniature poodles, miniature schnauzers
overweight dogs
what is pancreatitis?
premature activation of digestive enzymes within the acinar cells resulting in pancreas autodigestion due to secretory block
how does pancreatitis present?
vomiting
abdominal pain
anorexia
lethargy
what can pancreatitis lead to?
EPI chronic pancreatitis renal failure acute lung injury DIC
what is the treatment for pancreatitis?
supportive - IVFT, antiemetics, analgesia, gastro-protectants
nutrition is key
should pancreatitis patients be fasted?
no - no requirement to fast, causes increase in systemic inflammation
what effect does early enteral nutrition have on pancreatitis? (first 48 hours of admission)
reduced bacterial translocation
reduced villus atrophy
reduced pancreatic inflammation
what is important to remember when enteral feeding for pancreatitis?
avoid high fat diet due to concurrent hyperlipidaemia
prepyloric feeding well-tolerated in acute pancreatitis
lumen size may restrict diet choice
which dietary components are important for normal skeletal development/maintenance?
calcium
phosphorous
vitamin D
what is osteoarthritis?
progressive articular cartilage degradation
what are 3 common orthopaedic conditions?
osteoarthritis
joint dysplasia
cranial cruciate ligament rupture/luxating patellae
which dietary components are important in nutrition for arthritis?
weight management
omega 3 fatty acids (EPA/DHA - reduce inflammation)
glucosamine-chondroitin sulphate
what is the function of glucosamine-chondroitin sulphate?
cartilage formation and repair
reduce inflammation
slow cartilage degeneration
what are the dietary aims for treating diabetes?
achieving and maintaining normal serum glucose levels
decrease post-prandial glucose peaks
achieve normal metabolism of carbs/fats/proteins
normalise bodyweight
what does DMB mean?
dry matter basis
what % DMB should protein make up in a diabetes diet?
15-25% dogs
28-50% cats
what % DMB should fat make up in a diabetes diet?
<20% DMB - high fat increases insulin resistance
what % DMB should carbohydrate make up in a diabetes diet?
<30 DMB
what other component is important in a diabetes diet?
insoluble carbohydrate (fibre) - important factor in DB management
what dietary component is important to manage in hyperthyroidism?
iodine - dietary iodine required for production of thyroid hormone
how can feline hyperthyroidism be treated/managed?
0.2ppm iodine DMB
e.g. Hills y/d
important that cat eats absolutely nothing else
why should kidney function be monitored while treating hyperthyroidism?
can lower blood pressure = reduced perfusion to the kidneys
which dietary alterations may help treat cardiac disease?
mild sodium restriction
sufficient taurine, L-carnitine, arginine, omega 3 fatty acids
what is the importance of taurine in managing cardiac disease?
deficiency linked to DCM
especially relevant in cats
what is the importance of L-carnitine in managing cardiac disease?
myocardial energy production
synthesised from lysine and methionine
what is the importance of arginine in managing cardiac disease?
maintenance of normal vascular tone
what is the importance of omega 3 fatty acids in managing cardiac disease?
reduces muscle loss
anti-arrhythmic effects
how much L-carnitine should be included in the diet for cardiac disease?
50-100mg/kg PO q8h
